Provider Demographics
NPI:1417534942
Name:MCALLISTER, KELLY ANNE (APRN-NP-FAMILY)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:MCALLISTER
Suffix:
Gender:F
Credentials:APRN-NP-FAMILY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 KINSLEY ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3688
Mailing Address - Country:US
Mailing Address - Phone:603-882-3000
Mailing Address - Fax:603-578-5004
Practice Address - Street 1:172 KINSLEY ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3688
Practice Address - Country:US
Practice Address - Phone:603-882-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH049072-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3127139Medicaid